Testing drugs on pregnant women suffering from a life-threatening disease is not an easy decision to make. It’s not just about the mother-to-be and her illness, but there’s a second life to consider. So how do doctors strike a balance between the mother’s health and the fetus’ wellbeing? It takes a brave doctor, and a brave mother-to-be, to try and find an answer to that question.
In the 1950s, many women were prescribed thalidomide to help them sleep better and to reduce morning sickness. But its side effects led to around 400 deformed babies born in the UK, and many more elsewhere.
What went wrong? Its safety was presumed, rather than robustly tested. And while this tragedy did lead to a U-turn in drug testing – in the US, regulators tightened approval processes considerably in 1962 – that lack of thorough testing pre-launch meant many mothers, and their children, suffered needlessly.
Some doctors are daring to break the taboo of avoiding dispensing drugs altogether. Research by Dr. Amant from University Hospital Leuven, Belgium, found that survival rates of women with breast cancer are comparable between pregnant and non-pregnant women. And that chemotherapy, in the second and third trimesters, did not harm the unborn child. If 200 women had not braved chemotherapy during their pregnancy, other mothers-to-be would not be able to benefit from these findings.
And in Thailand, doctors gathered data on malaria treatment in women in the early stages of pregnancy. While it is well known that malaria is a considerable threat to an unborn child, doctors have long-struggled over what to prescribe pregnant women suffering from the disease. The findings in Thailand overturn previous conceptions over what drugs doctors should be prescribing, and while there are no clear answers, there are at least fewer questions as a result.
But it’s going to take many more brave doctors, and brave mothers-to-be, before answers to what drugs women can take during pregnancy become the exception, rather than the rule.